Fertility sparing treatments in young patients with gynecological cancers: Iranian experience and literature review.

With increase in the marriage age some women experience gynecological cancers before giving birth. Thus fertility sparing in these patients is an important point and much work has been done on conservative management. We here report our experience on fertility sparing with cervical, endometrial and ovarian cancers and include a review of the literature. With cervical cancer, radical trachelectomy with para-aortic and pelvic lymphadenectomy can be performed in patients with early stage IA1-IB cancers, because they have low recurrence rates. The complications are fewer than with radical hysterectomy. For endometrial cancer, the accepted treatment is total abdominal hysterectomy+bilateral salpango-oopherectomy (TAH+BSO), but in young patients with early stage 1 lesions, we can suggest use of hormonal therapy in place of radical surgery if we evaluate with MRI and the result is early stage disease without the other site involvement and the grade of tumor is well differentiated. GNRH analog, oral medroxyprogestrone acetate (MPA), 100-800 mg/day, megestrol acetate 40-160 mg/day and combination of tamoxifen and a progestin have been applied, but we must remember, they should underwent repeated curettage for investigating medical outcome after 3 months. With normal pathology we follow medical therapy for 3 months and can evaluate for infertility treatment. The best option for patients who treated by medical therapy is TAH+BSO after normal term pregnancy. With ovarian cancer, there is much experience on fertility sparing surgery and in Iran conservative surgical management in young patients with stage I (grade 1,2) of epithelial ovarian tumor and sex cord-stromal tumor and patients with borderline and germ cell ovarian tumors is being successfully performed.

The effects of acrylamide on sperm parameters and membrane integrity of epididymal spermatozoa in mice.

OBJECTIVE: Acrylamide is a chemically reactive substance used in various industries. Recently, the discovery of acrylamide in a variety of human foods including heat-processed starchy foods such as potato chips and bread has been reported. Acrylamide is also known as a carcinogen and cytotoxic material. The aim of this study was to evaluate the detrimental effects of acrylamide on membrane integrity and sperm parameters in mice. STUDY DESIGN: This experimental study was conducted on thirty male NMRI mice, aged 8-10 weeks and weighing 25-30 g. They were randomly allotted into three equal groups. Group I (low dose) and group II (high dose) were fed on water solutions containing acrylamide 5 and 10 mg/kg/day, respectively, for 2 months, while the third group received fresh water as the control group. Sperm analysis was done for parameters as well as evaluation of membrane integrity by Hypoosmotic Swelling Test (HOS-test) for sperm tails and Eosin-Y staining for sperm heads. RESULTS: Total sperm motility and progressive motility (fast and slow) in both groups, I and II, decreased significantly (P = 0.00), but no significant change was observed in non-progressive motility (P > 0.05). The total motile sperm percentage decreased significantly only in group II (P = 0.01). Sperm morphology did not significantly change in the experimental groups compared to the controls (P > 0.05). In sperm membrane integrity evaluation, functional intact membrane of sperm tail in both groups I and II had a significant decrease (P = 0.00), but membrane integrity of the sperm head decreased significantly only in group II (P = 0.00). CONCLUSION: These results indicate that acrylamide, through effects on membrane integrity, decreased sperm vitality as well as causing abnormal sperm parameters in progressive motility and total motility.